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Masoomi R, Lancaster E, Robinson A, Hacker E, Krajcer Z, Gupta K. Safety of EndoAnchors in real-world use: A report from the Manufacturer and User Facility Device Experience database. Vascular 2019; 27:495-499. [PMID: 30991897 PMCID: PMC6767639 DOI: 10.1177/1708538119844041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives A hostile proximal neck anatomy is the most common cause of abdominal aorta endovascular aneurysm repair failure leading to a higher risk of device migration, proximal type I endoleak, and subsequent open surgical repair. Endostapling is a technique to attain better fixation of the endograft to the aortic wall, and the only available device in the USA is Aptus Heli-FX EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA). Preliminary data have shown efficacy and safety of its use, and the aim of this study is to assess device-related adverse events in real-world clinical use. Methods We quarried data from the publicly available Manufacturer and User Facility Device Experience database to identify Aptus Heli-FX EndoAnchor system-related adverse reports in endovascular aneurysm repair since FDA approval till August 31, 2017. An estimate of total devices implanted in the United States was quoted around 7,000 (Medtronic marketing internal data). Results Our query identified 229 separate reports, of which there were 85 adverse events (1.2% of the estimated EndoAnchor systems used). The most common adverse events were device dislodgement/fracture (65) and applicator malfunction (20). Conclusion In early post-FDA approval use in a real-world setting, the EndoAnchor system is associated with a low rate of adverse events. Device dislodgement and embolization remain the most common adverse events. With increasing use of these devices in more difficult anatomy, careful patient selection and careful attention to technique may help to reduce these events even further.
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Almanfi A, Krajcer Z. Minimally Invasive Endovascular Repair of Ascending Thoracic Aortic Aneurysm with Use of Local Anesthesia and Conscious Sedation. Tex Heart Inst J 2019; 46:120-123. [PMID: 31236076 DOI: 10.14503/thij-17-6558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ascending thoracic aortic aneurysm (ATAA) is typically treated surgically. No commercially available device has been specifically designed for endovascular ATAA repair, and currently, multiple anatomic and technical challenges affect its feasibility. Previously, such repairs have been performed with the patients under general anesthesia. We describe a novel, minimally invasive approach to endovascular repair of ATAA, involving local anesthesia, conscious sedation, and 24-hour hospitalization. Two consecutive male patients (ages, 79 and 54 yr) who had comorbidities underwent percutaneous transfemoral endovascular ATAA repair with use of commercially available endografts. Patient 1 had a saccular aneurysm, and Patient 2 had a pseudoaneurysm consequent to recent surgical ATAA repair. The patients were discharged from the hospital 24 hours after technically successful, uncomplicated procedures. At 2 months, computed tomograms showed no endoleak or stent-graft migration. Our experience shows that minimally invasive endovascular ATAA repair is feasible for selected high-risk patients. We describe the procedure, access and closure devices, and challenges associated with this approach.
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Shatila W, Krajcer Z. Does single-valve surgery cause ischemia? Catheter Cardiovasc Interv 2019; 93:590-591. [PMID: 30859730 DOI: 10.1002/ccd.28181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 11/11/2022]
Abstract
Isolated valve surgery is associated with a small incidence of postoperative PCI. PCI after single-valve surgery is associated with elevated mortality and morbidity risk. Possible mechanisms for cardiac ischemia include iatrogenic causes (such as suture-related or air embolism), intimal hyperplasia, and immunologic reaction to the valve prosthesis.
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Shatila W, Krajcer Z. TAVI: How to best predict postprocedural outcomes? Catheter Cardiovasc Interv 2019; 93:E261. [DOI: 10.1002/ccd.28063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022]
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Parekh DR, Krajcer Z. Branch pulmonary artery stenting in children by using premounted stents: Can we benefit from slenderization? Catheter Cardiovasc Interv 2019; 93:E198-E199. [DOI: 10.1002/ccd.28010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022]
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Parekh DR, Krajcer Z. Percutaneous pulmonary valve implantation: It's not like the aortic valve. Catheter Cardiovasc Interv 2019; 93:464-465. [PMID: 30770667 DOI: 10.1002/ccd.28141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/08/2022]
Abstract
The Edwards Sapien S3 demonstrated clinical and technical feasibility in this cohort undergoing percutaneous pulmonary valve implantation. Traversing the tricuspid apparatus with an unsheathed delivery system continues to pose a risk for tricuspid valve injury. Future design innovations need to accommodate for large outflow tracts without adjacent aortic or coronary compression and allow for safe device delivery with minimal trauma to the tricuspid apparatus.
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Parekh DR, Krajcer Z. Percutaneous atrial septal occluders: Are we there yet? Catheter Cardiovasc Interv 2019; 93:322-323. [DOI: 10.1002/ccd.28080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 11/09/2022]
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Shatila W, Krajcer Z. Use of an AFX aortic cuff in the endovascular treatment of aortocaval fistula secondary to abdominal aortic pseudoaneurysm. Catheter Cardiovasc Interv 2018; 92:1352-1355. [PMID: 30260090 DOI: 10.1002/ccd.27830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 05/25/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022]
Abstract
Aortocaval fistula (ACF) is rare and lethal and can be either primary (due to an enlarged abdominal aortic aneurysm) or secondary (iatrogenic or secondary to abdominal surgery) in origin. We describe a case of an ACF secondary to a ruptured abdominal aortic pseudoaneurysm that we successfully treated with a planned endovascular approach using an AFX aortic cuff on both the arterial and venous sides.
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Shatila W, Krajcer Z. Plug vs. suture: Who wins in large bore access closure? Catheter Cardiovasc Interv 2018; 92:962-963. [PMID: 30450709 DOI: 10.1002/ccd.27951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022]
Abstract
Large Bore Access in increasingly common and surgical closure used to be the gold standard for closure. Novel less invasive closure devices such as the suture based vascular devices offer a safe alternative to surgery. Recent developments provide us with MANTA (Essential Medical Inc., Malvern, Pennsylvania) a vascular closure device that seems to be as safe and associated with less bleeding. Certain genetic polymorphisms might account for HoTPR.
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Shatila W, Krajcer Z. Aortic dissection: Is the false lumen really important? Catheter Cardiovasc Interv 2018; 92:741-742. [DOI: 10.1002/ccd.27882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 12/31/2022]
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Shatila W, Krajcer Z. Peripheral artery disease: How do genes and pharmacology interplay? Catheter Cardiovasc Interv 2018; 91:1318-1319. [DOI: 10.1002/ccd.27649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 11/06/2022]
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Shatila W, Krajcer Z. Chronic total occlusion: Does anti-platelet choice impact outcomes? Catheter Cardiovasc Interv 2018; 91:7-8. [PMID: 29314641 DOI: 10.1002/ccd.27456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/05/2022]
Abstract
Chronic total occlusion (CTO) is associated with worse outcomes compared to non CTO percutaneous coronary intervention (PCI). CTO might be associated with vasomotor dysfunction Ticagrelor is a novel P2Y12 inhibitor that increases local adenosine The TIGER-BVS trial plans to assess the impact of using ticagrelor vs. clopidogrel on vasomotor activity and outcomes after successful CTO PCI.
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Krajcer Z, Ramaiah VG, Henao EA, Metzger DC, Nelson WK, Moursi MM, Rajasinghe HA, Al-Dallow R, Miller LE. Perioperative Outcomes From the Prospective Multicenter Least Invasive Fast-Track EVAR (LIFE) Registry. J Endovasc Ther 2017; 25:6-13. [DOI: 10.1177/1526602817747871] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: To determine the feasibility, perioperative resource utilization, and safety of a fast-track endovascular aneurysm repair (EVAR) protocol in well-selected patients. Methods: Between October 2014 and May 2016, the LIFE (Least Invasive Fast-track EVAR) registry ( ClinicalTrials.gov identifier NCT02224794) enrolled 250 patients (mean age 73±8 years; 208 men) in a fast-track EVAR protocol comprised of bilateral percutaneous access using the 14-F Ovation stent-graft, no general anesthesia, no intensive care unit (ICU) admission, and next-day discharge. The primary endpoint was major adverse events (MAE) through 30 days. The target performance goal for the MAE endpoint was 10.4%. Results: Vascular access, stent-graft delivery, and stent-graft deployment success were 100%. A total of 216 (86%) patients completed all elements of the fast-track EVAR protocol. Completion of individual elements was 98% for general anesthesia avoidance, 97% for bilateral percutaneous access, 96% for ICU avoidance, and 92% for next-day discharge. Perioperative outcomes included mean procedure time of 88 minutes, median blood loss of 50 mL, early oral nutrition (median 6 hours), early mobilization (median 8 hours), and short hospitalization (median 26 hours). Fast-track EVAR completers had shorter procedure time (p<0.001), less blood loss (p=0.04), faster return to oral nutrition (p<0.001) and ambulation (p<0.01), and shorter hospital stay (p<0.001). With 241 (96%) of the 250 patients returning for the 30-day follow-up, the MAE incidence was 0.4% (90% CI 0.1% to 1.8%), significantly less than the 10.4% performance goal (p<0.001). No aneurysm rupture, conversion to surgery, or aneurysm-related secondary procedure was reported. There were no type III endoleaks and 1 (0.4%) type I endoleak. Iliac limb occlusion was identified in 2 (0.8%) patients. The 30-day hospital readmission rate was 1.6% overall. Conclusion: A fast-track EVAR protocol was feasible in well-selected patients and resulted in efficient perioperative resource utilization with excellent safety and effectiveness.
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Shatila W, Krajcer Z. A cardiologist's nightmare: Coronary obstruction during transcatheter aortic valve implantation: How to identify patients at highest risk for this complication. Catheter Cardiovasc Interv 2017; 90:1198-1199. [DOI: 10.1002/ccd.27425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 11/05/2022]
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Parekh DR, Krajcer Z. Recurrent coarctation of aorta after Norwood operation in single ventricle patients; the case of the missing ideal stent. Catheter Cardiovasc Interv 2017; 90:980-981. [PMID: 29148248 DOI: 10.1002/ccd.27395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/07/2022]
Abstract
Recurrent coarctation postoperative Norwood is poorly tolerated in single ventricle patients. Although transcatheter balloon angioplasty is considered first line, it often leads to inadequate or non-durable relief of obstruction. Transcatheter stent implantation provides excellent relief of obstruction but necessitates staged redilation to account for somatic growth in children. Stent technology, delivery systems, and procedural techniques will need to evolve to obviate reported adverse events mainly due to patient size.
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Shatila W, Krajcer Z. “To close or not to close?” When should vascular closure devices be used after cardiac catheterization procedures? Catheter Cardiovasc Interv 2017; 90:766-767. [DOI: 10.1002/ccd.27360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/09/2017] [Indexed: 11/11/2022]
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Mewissen MW, Jan MF, Kuten D, Krajcer Z. Laser-Assisted Transgraft Embolization: A Technique for the Treatment of Type II Endoleaks. J Vasc Interv Radiol 2017; 28:1600-1603. [PMID: 29056193 DOI: 10.1016/j.jvir.2017.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022] Open
Abstract
A transgraft embolization (TGE) technique was performed in a patient to treat a type II endoleak. Using a transfemoral arterial approach, the endograft was punctured using a coronary laser catheter aimed toward the type II endoleak nidus, which was treated with Onyx (Medtronic, Minneapolis, Minnesota). TGE resulted in successful embolization, as demonstrated on 1-year follow-up CT angiography, which showed complete elimination of the type II endoleak and shrinkage of the aneurysmal sac. TGE is an alternative to transarterial embolization, translumbar embolization, and transcaval embolization.
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Shatila W, Krajcer Z. Drug-coated balloons: "Do they still have a role in treating coronary artery disease?". Catheter Cardiovasc Interv 2017; 90:387-388. [PMID: 28891165 DOI: 10.1002/ccd.27307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/08/2022]
Abstract
Small vessels with coronary artery disease (CAD) are at high risk of restenosis, despite the use of drug-eluting stents (DESs). Drug-coated balloon (DCB) therapy offers a viable alternative to DESs for the management of small vessel CAD. The literature regarding the use of DCBs in lieu of the newer generation DESs to treat small vessel CAD is controversial.
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Shatila W, Krajcer Z. “ICE or not to ICE during LAAO?” What are the benefits and disadvantages of ICE during LAAO? Catheter Cardiovasc Interv 2017; 90:339-340. [DOI: 10.1002/ccd.27222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 11/07/2022]
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Parekh DR, Krajcer Z. Melody valve within a dysfunctional freestyle bioprosthesis: Yes, you can fit a round peg in a calcified hole. Catheter Cardiovasc Interv 2017; 89:1231. [PMID: 28612421 DOI: 10.1002/ccd.27140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/12/2022]
Abstract
Transcatheter pulmonary valve implantation (TPVI) within a failed bioprosthetic valve is safe and effective Coronary artery compression is a potential risk, requiring careful preimplantation balloon dilation testing Prestenting is required for TPVI in stentless conduits Improvements in right ventricular volume, pressure, pulmonary stenosis, and regurgitation can be maintained in the intermediate term Long-term risk for Melody valve endocarditis and valve dysfunction necessitates careful monitoring.
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Parekh D, Krajcer Z. Patent ductus arteriosus and pulmonary arterial hypertension: Is it closer to closure? Catheter Cardiovasc Interv 2017; 89:726-727. [DOI: 10.1002/ccd.27011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 11/06/2022]
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Parekh D, Krajcer Z. Atrial baffle stenting: A complex solution to an aging problem. Catheter Cardiovasc Interv 2017; 89:314-315. [PMID: 28206718 DOI: 10.1002/ccd.26922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/11/2022]
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